1338 - Chronic Prosthetic Joint Infection Turned Systemic: Implications for Surgical Timing and Rehabilitation

Thursday, February 19, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

ZL

Zachary Lin, DO

Resident Physician
UCF/HCA Florida West Hospital
Pensacola, Florida, United States

Co-Author(s)

MM

Mathew Mcgillivray, MD

Resident Physician
UCF/HCA Florida West Hospital
Pensacola, Florida, United States
JB

Justin Buck, DO

Resident Physician
UCF/HCA Florida West Hospital
Pensacola, Florida, United States
MC

Megan Craig, DO

Resident Physician
UCF/HCA Florida West Hospital
Pensacola, Florida, United States
MT

Marisa Terry, MD

Faculty
University of Central Florida/HCA Florida West Hospital
Pensacola, Florida, United States
SB

Susan Belcher, MD

Program Director
UCF/HCA Physical Medicine & Rehabilitation Residency
Pensacola, Florida, United States

Submitter(s)

ZL

Zachary Lin, DO

HCA Florida West Hospital
Pensacola, Florida, United States

Case Diagnosis: Disseminated Methicillin-Sensitive Staphylococcus aureus (MSSA) Infection Secondary to a Chronically Infected Left Total Knee Arthroplasty

Case Description:
A 75-year-old female presented with sepsis from a draining wound over the left tibial tuberosity. Evaluation revealed a chronically infected left total knee arthroplasty (TKA), previously revised 2–3 years earlier. Wound, blood, and urine cultures grew MSSA. The day following initial presentation, she underwent TKA explantation with placement of antibiotic-impregnated spacers and intramedullary rods. Despite IV cefazolin and rifampin, leukocytosis worsened.

CT abdomen/pelvis one week later showed a right psoas abscess and lobulated pelvic soft tissue mass. MRI lumbar spine revealed L3–L4 diskitis with a small epidural abscess causing moderate canal stenosis and neural foraminal narrowing. Brain MRI showed scattered acute-to-subacute ischemic infarcts bilaterally, likely cardioembolic in nature.

The patient was transferred to a tertiary care center for multidisciplinary management involving neurosurgery, orthopedics, neurology, interventional radiology, cardiology, and infectious disease specialists. Due to systemic dissemination of MSSA and worsening musculoskeletal involvement, a left above-knee amputation (AKA) with orthopedics was necessary.

Discussions:
This case illustrates the high risk of systemic dissemination in chronic prosthetic joint infections when definitive surgical intervention is delayed. Attempts to manage chronic infections non-operatively can lead to hematogenous spread with life-altering consequences—abscess, spinal infection, cerebral infarcts, and limb loss. Even with aggressive antibiotics and debridement, delayed intervention’s effects may be irreversible.

Following surgery, the patient faced significant impairments related to her AKA, spinal stenosis, and cognitive vulnerability from infarcts. Early physiatric involvement was critical for tailored rehabilitation planning, prosthetic readiness, endurance recovery, and safety assessment.

Conclusions: This case underscores the importance of early, aggressive management of chronic infections and highlights the physiatrist’s role in mitigating functional decline and restoring independence after complex systemic illness.